20180879 Ver 1_Shoreline Stabilization_20180622

201 80 878
State of North Carolina
Department of Environment and Natural Resources
DWR 19 1 WJ Division of Water Resources
Division of Water Resourcr$1 C 02H .0500 — Water Quality Certification, Shoreline Stabilization
FORM: SSGP 10-2013
Shoreline Stabilization Application Form
Three copies of the application (including attachments) and the application fee should be sent
to:
Division of Water Resources
401 & Buffer Permitting Unit
1617 Mail Service Center RECEIVED
Raleigh, NC 27699-1617 JUN 2
2 2018
I. Applicant Information [15A NCAC 02H .0502(a)) OENR-LAND Q'UALI'FY
1. Owner Information STOR%VAT`R PERMITTIN,,
Name: Paul R. Buck
Mailing Address: 2006 Red Forest Road
Greensboro NC 27410
Telephone Number: 336/706-0975 Fax Number:
E-mail Address: [e-mail]
2. Agent/ Contact Person Information
A signed and dated copy of the Agent Authorization letter (a form can be downloaded here:
http://www.saw.usace.armv.mil/Portals/59/docs/reeulatory/reedocs/Permits/SAMPLE AGENT AUTH
ORIZATION FORM.pdf) must be attached if the Agent has signed this application form.
Name: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Person to receive the Certification Approval:
11. Project Information [15A NCAC 02H .0502(a) & (b)]
1. Attach a vicinity map (i.e. street map) clearly showing the location of the property with
respect to local landmarks such as towns, rivers, and roads.
2. Provide a detailed site plan showing property boundaries and proposed locations of
vegetation clearing, structures (buildings, retaining walls, docks, impervious surfaces,
FORM: SSGP 10-2013 Page 1 of 4

etc.), rip rap, excavation or dredging below Full Pond/ Normal Water Level elevations,
and construction access corridors. You may use the diagram provided at the end of this
application form.
3. Attach a photograph of the shoreline/ buffer proposed to be stabilized. (Include a scale
of some sort- a yard stick, shovel handle, etc.)
4. Location of the property (where work is to be conducted)
County: Davidson Nearest Town: Lexington
Subdivision name or site address (include phase/lot number):
Lot 54 Riverview Acres at 1060 Riverview Road
Directions to site - please include road names and numbers, landmarks, etc.:
1-85 to Lexington exit for NC Hwy 8, go south on NC Hwy 8, R on Linwood — Southmont
Road, L on Riverview Road, #1060 is on the right side of road.
Latitude (in decimal degrees) ---- Longitude (decimal degrees)
5. Describe the existing land use or condition of the site at the time of this application
(residential, undeveloped, etc.): Single-family residential community
6. Property size (acres): Approx. 0.25 acres
7. Lake/ river/ ocean adjacent to property: High Rock Lake
8. Describe proposed work (include discussion as to how hardening of shoreline has been
avoided, or why it is necessary): To stabilize an eroding shoreline and protect it from
further erosion.
9. Will work be conducted from land? ® From water? ❑
10. Total amount of disturbance (including all excavation, backfill, rip rap, retaining walls, etc.)
below the normal pool lake level/ Normal Water Level in square feet or acres:
116 So. Ft.
11. Total amount of disturbance (including all clearing, back fill, excavation, rip rap, retaining
walls, etc.) above the normal pool lake level/ Normal Water Level and 50 feet land -ward in
square feet or acres: 754 Sq. Ft.
12. Please describe the vegetation above the normal pool lake level/ Normal Water Level and
50 feet landward to be impacted (number of trees, for instance): Three trees of varied
species, size and condition will be removed in order to complete the stabilization proiect.
Owner/Agen s Signature* [15A NCAC 02H .0502(f)] Date
'Agent's signature is valid only if an authorization letter from the owner is provided.
FORM: SSGP 10-2013 Page 2 of 3

Full Pond/
Normal Water I swpl
SI
lake
(AtFuN Pond/Norma) walerLeveQ
SEE ATTACHED SITE PLAN AND DETAIL
Please approximately sketch the following information on this plan (provide dimensions for each
item, such as 10 ft x 100 ft)*:
1. All proposed vegetation clearing
2. Location of rip rap or fill to be placed above the Full Pond/ Normal Water Level elevation
3. Location of rip rap or fill to be placed below the Full Pond/ Normal Water Level elevation
4. Location of any proposed structures such as buildings, retaining walls, docks, etc.
5. Location of any excavation or dredging below the Full Pond/ Normal Water Level elevation
b. Location of construction access corridors
FORM: SSGP 10-2013 Page 3 of 3

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VEGETATION AND EROSION
CONTROL FABRIC
EXISTING GRADE
CLASS 2 RIP RAP
HIGH WATER ELEV.
EROSION CONTROL FABRIC
LAKE Bp1TpM
TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE
FOR: PAUL BUCK
LOCATION: 1060 RIVERVIEW ROAD
HIGH ROCK LAKE
RESERVOIR:
PROJECT: SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. - BADIN, NORTH CAROLINA
DRAWING TITLE: DETAIL
MODERATE RIP RAP STABILIZATION 1 3

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